Use of a cohorting-unit and systematic surveillance cultures to control a Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae outbreak

Allison E. Reeme, Sarah L. Bowler, Blake W. Buchan, Mary Beth Graham, Elizabeth Behrens, Siddhartha Singh, Johnny C. Hong, Jennifer Arvan, Joshua W. Hyke, Louis Palen, Sabrina Savage, Heather Seliger, Susan Huerta, Nathan A. Ledeboer, Shireen Kotay, Amy J. Mathers, Vaughn S. Cooper, Mustapha Munir Mustapha, Roberta T. Mettus, Yohei DoiL. Silvia Munoz-Price

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1 Citation (Scopus)

Abstract

Objective: Describe the epidemiological and molecular characteristics of an outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing organisms and the novel use of a cohorting unit for its control.Design: Observational study.Setting: A 566-room academic teaching facility in Milwaukee, Wisconsin.Patients: Solid-organ transplant recipients.Methods: Infection control bundles were used throughout the time of observation. All KPC cases were intermittently housed in a cohorting unit with dedicated nurses and nursing aids. The rooms used in the cohorting unit had anterooms where clean supplies and linens were placed. Spread of KPC-producing organisms was determined using rectal surveillance cultures on admission and weekly thereafter among all consecutive patients admitted to the involved units. KPC-positive strains underwent pulsed-field gel electrophoresis and whole-genome sequencing.Results: A total of 8 KPC cases (5 identified by surveillance) were identified from April 2016 to April 2017. After the index patient, 3 patients acquired KPC-producing organisms despite implementation of an infection control bundle. This prompted the use of a cohorting unit, which immediately halted transmission, and the single remaining KPC case was transferred out of the cohorting unit. However, additional KPC cases were identified within 2 months. Once the cohorting unit was reopened, no additional KPC cases occurred. The KPC-positive species identified during this outbreak included Klebsiella pneumoniae, Enterobacter cloacae complex, and Escherichia coli. blaKPC was identified on at least 2 plasmid backbones.Conclusions: A complex KPC outbreak involving both clonal and plasmid-mediated dissemination was controlled using weekly surveillances and a cohorting unit.

Original languageEnglish
Pages (from-to)767-773
Number of pages7
JournalInfection Control and Hospital Epidemiology
Volume40
Issue number7
DOIs
Publication statusPublished - 01-07-2019

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Klebsiella pneumoniae
Enterobacteriaceae
Disease Outbreaks
Infection Control
carbapenemase
Plasmids
Enterobacter cloacae
Pulsed Field Gel Electrophoresis
Observational Studies
Teaching
Nursing
Nurses
Observation
Genome
Escherichia coli
Transplants

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Reeme, Allison E. ; Bowler, Sarah L. ; Buchan, Blake W. ; Graham, Mary Beth ; Behrens, Elizabeth ; Singh, Siddhartha ; Hong, Johnny C. ; Arvan, Jennifer ; Hyke, Joshua W. ; Palen, Louis ; Savage, Sabrina ; Seliger, Heather ; Huerta, Susan ; Ledeboer, Nathan A. ; Kotay, Shireen ; Mathers, Amy J. ; Cooper, Vaughn S. ; Mustapha, Mustapha Munir ; Mettus, Roberta T. ; Doi, Yohei ; Munoz-Price, L. Silvia. / Use of a cohorting-unit and systematic surveillance cultures to control a Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae outbreak. In: Infection Control and Hospital Epidemiology. 2019 ; Vol. 40, No. 7. pp. 767-773.
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title = "Use of a cohorting-unit and systematic surveillance cultures to control a Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae outbreak",
abstract = "Objective: Describe the epidemiological and molecular characteristics of an outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing organisms and the novel use of a cohorting unit for its control.Design: Observational study.Setting: A 566-room academic teaching facility in Milwaukee, Wisconsin.Patients: Solid-organ transplant recipients.Methods: Infection control bundles were used throughout the time of observation. All KPC cases were intermittently housed in a cohorting unit with dedicated nurses and nursing aids. The rooms used in the cohorting unit had anterooms where clean supplies and linens were placed. Spread of KPC-producing organisms was determined using rectal surveillance cultures on admission and weekly thereafter among all consecutive patients admitted to the involved units. KPC-positive strains underwent pulsed-field gel electrophoresis and whole-genome sequencing.Results: A total of 8 KPC cases (5 identified by surveillance) were identified from April 2016 to April 2017. After the index patient, 3 patients acquired KPC-producing organisms despite implementation of an infection control bundle. This prompted the use of a cohorting unit, which immediately halted transmission, and the single remaining KPC case was transferred out of the cohorting unit. However, additional KPC cases were identified within 2 months. Once the cohorting unit was reopened, no additional KPC cases occurred. The KPC-positive species identified during this outbreak included Klebsiella pneumoniae, Enterobacter cloacae complex, and Escherichia coli. blaKPC was identified on at least 2 plasmid backbones.Conclusions: A complex KPC outbreak involving both clonal and plasmid-mediated dissemination was controlled using weekly surveillances and a cohorting unit.",
author = "Reeme, {Allison E.} and Bowler, {Sarah L.} and Buchan, {Blake W.} and Graham, {Mary Beth} and Elizabeth Behrens and Siddhartha Singh and Hong, {Johnny C.} and Jennifer Arvan and Hyke, {Joshua W.} and Louis Palen and Sabrina Savage and Heather Seliger and Susan Huerta and Ledeboer, {Nathan A.} and Shireen Kotay and Mathers, {Amy J.} and Cooper, {Vaughn S.} and Mustapha, {Mustapha Munir} and Mettus, {Roberta T.} and Yohei Doi and Munoz-Price, {L. Silvia}",
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Reeme, AE, Bowler, SL, Buchan, BW, Graham, MB, Behrens, E, Singh, S, Hong, JC, Arvan, J, Hyke, JW, Palen, L, Savage, S, Seliger, H, Huerta, S, Ledeboer, NA, Kotay, S, Mathers, AJ, Cooper, VS, Mustapha, MM, Mettus, RT, Doi, Y & Munoz-Price, LS 2019, 'Use of a cohorting-unit and systematic surveillance cultures to control a Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae outbreak', Infection Control and Hospital Epidemiology, vol. 40, no. 7, pp. 767-773. https://doi.org/10.1017/ice.2019.99

Use of a cohorting-unit and systematic surveillance cultures to control a Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae outbreak. / Reeme, Allison E.; Bowler, Sarah L.; Buchan, Blake W.; Graham, Mary Beth; Behrens, Elizabeth; Singh, Siddhartha; Hong, Johnny C.; Arvan, Jennifer; Hyke, Joshua W.; Palen, Louis; Savage, Sabrina; Seliger, Heather; Huerta, Susan; Ledeboer, Nathan A.; Kotay, Shireen; Mathers, Amy J.; Cooper, Vaughn S.; Mustapha, Mustapha Munir; Mettus, Roberta T.; Doi, Yohei; Munoz-Price, L. Silvia.

In: Infection Control and Hospital Epidemiology, Vol. 40, No. 7, 01.07.2019, p. 767-773.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Use of a cohorting-unit and systematic surveillance cultures to control a Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae outbreak

AU - Reeme, Allison E.

AU - Bowler, Sarah L.

AU - Buchan, Blake W.

AU - Graham, Mary Beth

AU - Behrens, Elizabeth

AU - Singh, Siddhartha

AU - Hong, Johnny C.

AU - Arvan, Jennifer

AU - Hyke, Joshua W.

AU - Palen, Louis

AU - Savage, Sabrina

AU - Seliger, Heather

AU - Huerta, Susan

AU - Ledeboer, Nathan A.

AU - Kotay, Shireen

AU - Mathers, Amy J.

AU - Cooper, Vaughn S.

AU - Mustapha, Mustapha Munir

AU - Mettus, Roberta T.

AU - Doi, Yohei

AU - Munoz-Price, L. Silvia

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Objective: Describe the epidemiological and molecular characteristics of an outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing organisms and the novel use of a cohorting unit for its control.Design: Observational study.Setting: A 566-room academic teaching facility in Milwaukee, Wisconsin.Patients: Solid-organ transplant recipients.Methods: Infection control bundles were used throughout the time of observation. All KPC cases were intermittently housed in a cohorting unit with dedicated nurses and nursing aids. The rooms used in the cohorting unit had anterooms where clean supplies and linens were placed. Spread of KPC-producing organisms was determined using rectal surveillance cultures on admission and weekly thereafter among all consecutive patients admitted to the involved units. KPC-positive strains underwent pulsed-field gel electrophoresis and whole-genome sequencing.Results: A total of 8 KPC cases (5 identified by surveillance) were identified from April 2016 to April 2017. After the index patient, 3 patients acquired KPC-producing organisms despite implementation of an infection control bundle. This prompted the use of a cohorting unit, which immediately halted transmission, and the single remaining KPC case was transferred out of the cohorting unit. However, additional KPC cases were identified within 2 months. Once the cohorting unit was reopened, no additional KPC cases occurred. The KPC-positive species identified during this outbreak included Klebsiella pneumoniae, Enterobacter cloacae complex, and Escherichia coli. blaKPC was identified on at least 2 plasmid backbones.Conclusions: A complex KPC outbreak involving both clonal and plasmid-mediated dissemination was controlled using weekly surveillances and a cohorting unit.

AB - Objective: Describe the epidemiological and molecular characteristics of an outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing organisms and the novel use of a cohorting unit for its control.Design: Observational study.Setting: A 566-room academic teaching facility in Milwaukee, Wisconsin.Patients: Solid-organ transplant recipients.Methods: Infection control bundles were used throughout the time of observation. All KPC cases were intermittently housed in a cohorting unit with dedicated nurses and nursing aids. The rooms used in the cohorting unit had anterooms where clean supplies and linens were placed. Spread of KPC-producing organisms was determined using rectal surveillance cultures on admission and weekly thereafter among all consecutive patients admitted to the involved units. KPC-positive strains underwent pulsed-field gel electrophoresis and whole-genome sequencing.Results: A total of 8 KPC cases (5 identified by surveillance) were identified from April 2016 to April 2017. After the index patient, 3 patients acquired KPC-producing organisms despite implementation of an infection control bundle. This prompted the use of a cohorting unit, which immediately halted transmission, and the single remaining KPC case was transferred out of the cohorting unit. However, additional KPC cases were identified within 2 months. Once the cohorting unit was reopened, no additional KPC cases occurred. The KPC-positive species identified during this outbreak included Klebsiella pneumoniae, Enterobacter cloacae complex, and Escherichia coli. blaKPC was identified on at least 2 plasmid backbones.Conclusions: A complex KPC outbreak involving both clonal and plasmid-mediated dissemination was controlled using weekly surveillances and a cohorting unit.

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